The suture-pulley method for endolumenal triangulation in endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) is a time-consuming and technically demanding technique [1] [2] [3]. The main difficulty is the lack of triangulated countertraction with current endoscopes [4]. To improve speed and efficacy of the procedure, an intriguing pulley method using dental floss together with endoscopic clips has recently been described [5]. However, current clip technology is unlikely to provide a robust and dependable anchor for this “pulley” technique.